Lesbian and bisexual older women are more likely than heterosexual older women to suffer chronic health conditions, experience sleep problems and drink excessively, a new University of Washington study finds.

In general, lesbian, gay and bisexual (LGB) older adults were found to be in poorer health than heterosexuals, specifically in terms of higher rates of cardiovascular disease, weakened immune system and low back or neck pain. They also were at greater risk of some adverse health behaviors such as smoking and excessive drinking. At the same time, however, findings point to areas of resilience, with more LGB adults engaging in preventive health measures, such as obtaining HIV tests and blood pressure screening.

The study is the first to use national, population-based data to evaluate differences in health outcomes and behaviors among lesbian, gay and bisexual older adults. Using two-year survey data of 33,000 heterosexual and LGB adults ages 50 and older from a probability-based study of the U.S. Centers for Disease Control and Prevention, researchers from the UW School of Social Work report noticeable health disparities between LGB and heterosexual adults.

The findings were published in the August issue of the American Journal of Public Health.

While this study did not delve into what causes the poorer health outcomes, UW social work professor Karen Fredriksen-Goldsen pointed to other research, including the landmark longitudinal study, Aging with Pride: National Health, Aging and Sexuality/Gender Study, that has identified associated factors.

"The strong predictors of poor health are discrimination and victimization," said Fredriksen-Goldsen, the principal investigator on Aging with Pride, which surveyed 2,450 adults aged 50 to 100, studying the impact of historical, environmental, psychological, social, behavioral and biological factors on LGBT older adult health and well-being.

The new UW study relied on the 2013-14 National Health Interview Survey, which for the first time asked respondents about their sexual orientation. In the United States, approximately 2.7 million adults age 50 and older self-identify as lesbian, gay, bisexual or transgender. This number is expected to increase to more than 5 million by 2060.

Among the UW study's findings:

Disability and mental distress are significantly more prevalent among lesbians or gay men than among their bisexual counterparts.

More LGB people reported weakened immune systems: about 17 percent of women, and 15 percent of men, compared to 10 percent of heterosexual women, and 5 percent of heterosexual men.

Lesbian and bisexual women were up to two times as likely to engage in adverse health behaviors such as excessive drinking.

More than three-fourths of gay and bisexual men, and almost half of lesbians and bisexual women, had received an HIV test. In contrast, roughly one-fourth of heterosexuals had obtained a test. Slightly more lesbian and bisexual women had health insurance than heterosexual women, a possible reflection of professional choices, financial independence or same-sex partner benefits. But the health disparities among lesbian and bisexual women indicate a population that merits greater attention, Fredriksen-Goldsen said.

"Most people think gay and bisexual men would have more adverse health effects, because of the HIV risk," she said. "Lesbian and bisexual women tend to be more invisible, less often considered when it comes to health interventions. This is a population that isn't getting the attention it deserves," she said.

Bisexual men and women, meanwhile, may be marginalized not only in the general population, but also within gay and lesbian communities. As a result, bisexuals report feeling more isolated and experience greater stress, which, in turn, could lead to more adverse health conditions associated with stress as well as frequent risky health behaviors, Fredriksen-Goldsen said.

Like Aging with Pride, this new national study brings to light the need to target prevention efforts and health care services to improve health and the quality of life of LGB older adults, Fredriksen-Goldsen said.

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